air quality permit checklist

Transcript

1 Management South Coast Air Quality Office Small Business Assistance 800 1 - 388 - 2121 - District [email protected] 21865 Copley Drive, Diamond Bar, CA 91765 - 4182 www.aqmd.gov Air Quality Permit Checklist screening South Coast Air Quality Management District (SCAQMD) developed this Air Quality Checklist as a California Government Code Section 65850.2 . Please provide a evaluation tool by in the process required response to all questions on this checklist. Small If you have any question or need assistance completing this checklist, please contact the SCAQMD’s Assistance Office in the checklist. information Business , and a representative will help you complete the issue SCAQMD may decline to this form due to lack of information from applicant. demolition or renovation activities that may disturb building materials , please NOTE: If there are any contact the - . Asbestos Hotline at 909 - 396 2336 Operator/Business Information Secti on A - 1. Business Name: 2. Address: _____ ___________________________________________ ______________________________ CA ____________ Zip Street City Telephone Number: 3. Contact Name: Email: Title: Facility Business Information/Business and Equipment Description Section B - ed to be performed and equipment to be used at this location: provide Please a detail description of the business operations Section C - Checklist Questionnaire Please respond to all questions as it relates to the business activities to be performed at this location. Will business operations at this location: Result in the release of air pollutants, including but not limited to, dust, fumes, gas, mist, odors, sm oke, vapor, or 1. Yes No a combination of these to the atmosphere? Result in the use of fuel rs, and internal burning equipment including, but not limited to, boilers, generato 2. - Yes No combustion engines? als, plastics, rubber, resins, solvents, 3. Result in the use of hazardous materials, including but not limited to, chemic Yes No paints, and parts cleaners? Page 2 of 1 Rev. - 18 - 17 10

2 Section C Checklist Questionnaire (continued) - 4. Result in the use of an above or underground storage tank? Yes No 5. Consist of manufacturing, fabrication, finishing, or treatment of wood, metal or plastic products: Yes No es Result in the use of any of the equipment listed below: Y 6. No (Select all that apply) Soldering Oven Abrasive Blasting Cabinet/Room Air Conditioning Systems (containing > 50 lbs of refrigerant) Spray Booth Application of Paints/Adhesives/Resins Storage of Acids/Solvents/Organic Baghouse/Dust Collector Liquids/Fuels Storage Silos (sugar, flour, etc.) Bakery Oven (gas - fired) Boiler/Water Heater (max. heat input = or > 1 million BTU/hr) Charbroiler/Smoker Coffee Roaster/Afterburner (excluding equipment located at eating establishments) Deep Fryer Dry Cleaning Equipment Electrostatic Precipitator Etching/Plating/Casting/Melting /Forging/Grinding/Cutting of Metals Fermentation Gasoline Storage & Dispensing Equipment Internal Combustion Engine (rated > 50 bhp; e.g. back - up generator) Mixing/Blen ding of Liquids and/or Powders g/Extruding/Curing of Plastics Moldin P harmaceutical/Nutraceutical Plasma/Laser Cutter Printing/Coating/Drying Produc tion of Fumes/Dust/Smoke/ Odors Refrigeration Systems (containing > 50 lbs of refrigerant) Business Self Certification - Section D 7. Preparer: Title: Date Signature: : Telephone Number: named business, and I hereby certify by my signature above that, I am a duly authorized representative of the above - that all information contained herein is true and correct. Equipment: Issued By: Applicant has permit(s) from the SCAQMD: Applicant has filed for permit(s) with the SCAQMD: Applicant is exempt from permit requirements: SCAQMD USE ONLY Applicant has complied with filing requirements of R222: provided, no equipment/process requiring air Based on the information quality permit or registration. of 2 2 Page Rev. 17 10 - 18 -

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